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From 1990 to 2019, the age-standardized incidence rate of nutritional deficiencies in China remained stable. However, the age-standardized disability-adjusted life-years (DALY) rate of nutritional deficiencies decreased from 1990 to 2019. Data were extracted from the GBD 2019 datasets. Estimated annual percentage changes (EAPCs) were calculated to assess the incidence rate, and DALY trends of nutritional deficiencies. Measures were stratified by subtypes, regions, and age groups. In 2019, the age-standardized DALY rates of dietary iron deficiency and protein-energy malnutrition reached their highest levels. The main population groups with protein-energy malnutrition and dietary iron deficiency were adults over the age of 70 and children under the age of five. The latter group also had a greater burden of vitamin A deficiency. Zhejiang, Beijing, and Guangdong reported the highest age-standardized incidence rates of nutritional deficiencies, which mainly pertained to protein-energy malnutrition and vitamin A deficiency. Tibet, Xinjiang, and Hainan had the highest age-standardized DALY rates of nutritional deficiencies, which mainly pertained to dietary iron deficiency and protein-energy malnutrition.

Background The Coronavirus Disease 2019 (COVID-19) that first occurred in Wuhan, China, is currently spreading throughout China. The majority of infected patients either traveled to Wuhan or came into contact with an infected person from Wuhan. Investigating members of the public with a travel history to Wuhan became the primary focus of the Chinese government’s epidemic prevention and control measures, but several instances of withheld histories were uncovered as localized clusters of infections broke out. This study investigated the public’s willingness and beliefs associated with reporting travel history to high-risk epidemic regions, to provide effective suggestions and measures for encouraging travel reporting. Methods A cross-sectional study was conducted online between February 12 and 19, 2020. Descriptive analysis, chi-squared test, and Fisher’s exact test were used to identify socio-demographic factors and beliefs associated with reporting, as well as their impact on the willingness to report on travel history to high-risk epidemic regions. Results Of the 1344 respondents, 91 (6.77%) expressed an inclination to deliberately withhold travel history. Those who understood the benefits of reporting and the legal consequences for deliberately withholding information, showed greater willingness to report their history (P P Conclusions As any incident of withheld history can have unpredictable outcomes, the proportion of people who deliberately withhold information deserves attention. Appropriate public risk communication and public advocacy strategies should be implemented to strengthen the understanding that reporting on travel history facilitates infection screening and prompt treatment, and to decrease the fear of potentially becoming quarantined after reporting. Additionally, social support and policies should be established, and measures should be taken to alleviate stigmatization and discrimination against potential patients and reporters of travel history. Reinforcing the legal accountability of withholding travel history and strengthening systematic community monitoring are the measures that China is currently taking to encourage reporting on travel history to high-risk epidemic regions. These non-pharmaceutical interventions are relevant for countries that are currently facing the spread of the epidemic and those at risk of its potential spread.

Background China’s fragmentation of social health insurance schemes has become a key obstacle that hampers equal access to health care and financial protection. This study aims to explores if the policy intervention Urban and Rural Residents Basic Medical Insurance (URRBMI) scheme, which integrates Urban Resident Basic Medical Insurance (URBMI) and New Rural Cooperative Medical Scheme (NCMS), can curb the persistent inequity of catastrophic health expenditure (CHE) and further analyses the determinants causing inequity. Methods Data were derived from the Fifth National Health Service Survey (NHSS). A total of 11,104 households covered by URRBMI and 20,590 households covered by URBMI or NCMS were selected to analyze CHE and the impoverishment rate from medical expenses. Moreover, the decomposition method based on a probit model was employed to analyse factors contributing CHE inequity. Results The overall incidence of CHE under integrated insurance scheme was 15.53%, about 1.10% higher than the non-integrated scheme; however, the intensity of CHE and impoverishment among the poorest was improved. Although CHE was still concentrated among the poor under URRBMI (CI = -0.53), it showed 28.38% lower in the degree of inequity. For URRBMI households, due to the promotion of integration reform to the utilization of rural residents’ better health services, the factor of residence (24.41%) turns out to be a major factor in increasing inequity, the factor of households with hospitalized members (− 84.53%) played a positive role in reducing inequity and factors related to social economic status also contributed significantly in increasing inequity. Conclusion The progress made in the integrated URRBMI on CHE equity deserves recognition, even though it did not reduce the overall CHE or the impoverishment rate effectively. Therefore, for enhanced equity, more targeted solutions should be considered, such as promoting more precise insurance intervention for the most vulnerable population and including costly diseases suitable for outpatient treatment into benefit packages. Additionally, comprehensive strategies such as favourable targeted benefit packages or job creation are required for the disadvantaged.

Background Hostility can result in negative outcomes in people living with HIV/AIDS (PLWHA); however, previous research on this topic is far from adequate. To contribute to existing knowledge on this aspect of PLWHA, the current study examined the prevalence of hostility and its potential influencing factors among PLWHA. Methods A cross-sectional questionnaire survey was undertaken on 218 HIV patients in Heilongjiang Province of China between March and August in 2013. A multiple logistic regression analysis was performed to identify factors associated with hostility. Results The prevalence of hostility was 17.0% among the participants. The three most alarming types of hostility included desiring to kill the person who infected them, blaming the infection on the society, and abandoning themselves to despair. A multiple logistic regression model identified that depression (OR = 3.845, 95% CI = 1.309–9.229), perceived stigma (OR = 3.281, 95% CI = 1.109–7.711), and fear of dying (OR = 2.710, 95% CI = 1.068–6.881) were the risk factors for hostility, while higher levels of trust-in-doctor (OR = 0.176, 95% CI = 0.060–0.517) and per capita household income (OR = 0.344, 95% CI = 0.119–0.991) were protective factors. Conclusions Our findings highlight the prominent influence of psychological, healthcare, and social factors on hostility among PLWHA. Interventions specifically targeted to reduce hostility should be provided, including incorporating psychological service into HIV management guidelines, enhancing PLWHA’s trust-in-doctor, establishing comprehensive services for PLWHA, reducing the social stigma against PLWHA, and paying more attention to PLWHA with financial problems. These interventions may improve the management and control of HIV/AIDS.

Background To evaluate the impact of a restricted access policy on workplace violence in a healthcare setting. Methods We surveyed healthcare workers before and after the implementation of a restricted-access policy at a tertiary hospital in north-eastern China. Data were collected in April 2017 and January 2019. Fisher’s exact test were used to compare the difference in workplace violence prevalence between responses to two surveys. Survey 1 (S1) collected data from 345 healthcare professionals who had worked in the inpatient ward for at least 12 months. Survey 2 (S2) included 338 healthcare workers from the same ward who had been employed for more than two years. The effective response rates for the two studies was 79.31 and 83.25%, respectively. All 18 female security guards were included in the investigation in S2. Results The prevalence of psychological violence was 62.03% in S1 and 34.62% in S2, the difference in prevalence showing statistical significance (P = 0.000), while the prevalence of physical violence was 3.77 and 4.73% respectively, showing no statistical significance (P = 0.573). The change in the rate of injury caused by physical violence was also statistically significant at 76.92 and 31.25% (P = 0.025), respectively. Security guards were at high risk of workplace violence under the policy. Most healthcare professionals thought this policy ameliorated treatment order, the sense of security, anxiety about workplace violence, and so forth, but one-third of the respondents thought that it caused patient dissatisfaction. Conclusion While the restricted access policy may be effective for healthcare professionals in avoiding or dealing with violence, such policy could contribute to new problems regarding the safety of security guards and the potential dissatisfaction of patients. The policy should be further developed to alleviate this phenomenon.

STUDY QUESTION What is the current burden of polycystic ovary syndrome (PCOS) at the global, regional, and country-specific levels in 194 countries and territories according to age and socio-demographic index (SDI)? SUMMARY ANSWER Slight increases in age-standardized incidence of PCOS and associated disability-adjusted life-years (DALYs) were evidenced among women of reproductive age (15–49 years) from 2007 to 2017 at the global level, and in most regions and countries. WHAT IS KNOWN ALREADY No detailed quantitative estimates of the PCOS incidence and DALYs by age and SDI in these 194 countries and territories have been published previously. STUDY DESIGN, SIZE, DURATION An age- and SDI-stratified systematic analysis of the PCOS incidence and DALYs across 194 countries and territories has been performed. PARTICIPANTS/MATERIALS, SETTING, METHODS We used data from the Global Burden of Diseases, Injuries and Risk Factors Study (GBD) 2017 to estimate the total and age-standard PCOS incidence rates and DALYs rates among women of reproductive age in both 2007 and 2017, and the trends in these parameters from 2007 to 2017. MAIN RESULTS AND THE ROLE OF CHANCE Globally, women of reproductive age accounted for 1.55 million (95% uncertainty intervals (UIs): 1.19–2.08) incident cases of PCOS and 0.43 million (0.19–0.82) associated DALYs. The global age-standardized PCOS incidence rate among women of reproductive age increased to 82.44 (64.65–100.24) per 100 000 population in 2017, representing an increase of 1.45% (1.43–1.47%) from 2007 to 2017. The rate of age-standardized DALYs increased to 21.96 (12.78–31.15) per 100 000 population in 2017, representing an increase of 1.91% (1.89–1.93%) from 2007 to 2017. Over the study period, the greatest increase in the age-standardized PCOS incidence and DALYs rates were observed in the middle-SDI and high-middle SDI regions, respectively. At the GBD regional level, the highest age-standardized incidence and DALY rates in 2017 were observed in Andean Latin America, whereas the largest percentage increases in both rates from 2007 to 2017 were observed in Tropical Latin America. At the national level, Ecuador, Peru, Bolivia, Japan, and Bermuda had the highest age-standardized incidence rates and DALYs rates in both 2007 and 2017. The highest increases in both the age-standardized incidence rates and DALYs rates from 2007 to 2017 were observed in Ethiopia, Brazil, and China. LIMITATIONS, REASONS FOR CAUTION Although the GBD (2017) study aimed to gather all published and unpublished data, the limited availability of data in some regions might have led to the estimation of wide UIs. Additionally, the PCOS phenotype is complicated and the diagnostic criteria are constantly changing. Consequently, the incidence of PCOS might have been underestimated. WIDER IMPLICATIONS OF THE FINDINGS Knowledge about the differences in the PCOS burden across various locations will be valuable for the allocation of resources and formulation of effective preventive strategies. STUDY FUNDING/COMPETING INTEREST(S) The study was supported by grants from the Innovative Talent Support Plan of the Medical and Health Technology Project in Zhejiang Province (2021422878), Ningbo Science and Technology Project (202002N3152), Ningbo Health Branding Subject Fund (PPXK2018-02), Sanming Project of Medicine in Shen-zhen (SZSM201803080), and National Social Science Foundation (19AZD013). No potential conflicts of interest relevant to this article were reported. TRIAL REGISTRATION NUMBER N/A

The purpose of our research was to (a) identify sleep quality complications experienced by patients living with HIV infection and treated with antiretroviral therapy (ART), and (b) explore factors associated with sleep quality complications. From March to August in 2013, a cross-sectional study was conducted at HIV-designated hospitals in Harbin of Heilongjiang Province, China. Participants completed a questionnaire using the Spiegel scale to assess sleep quality; 32.1% of patients were negatively affected by sleep disturbances. Nighttime dreams and waking up were the most serious complications. We found that anxiety was the most prominent factor contributing to poor sleep quality, followed by ART medication types and family and social support. Patients with HIV infection and receiving ART experienced many different types of sleep complications. More attention should be given to the development of treatment guidelines for proper management of sleep disturbances experienced by patients with HIV.

Objective Assessing the patient safety culture is necessary for improving patient safety. Research on patient safety culture has attracted considerable attention. Currently, there is little research on patient safety culture in China generally, and in Heilongjiang in northern China specifically. The aim of the study is to explore the perception of healthcare employees about patient safety culture and to determine whether perception differs per sex, age, profession, years of experience, education level and marital status. Design Cross-sectional study. Setting Thirteen tertiary hospitals in Heilongjiang, northern China. Participants About 1024 healthcare employees. Main outcome measure The perception of healthcare employees was measured using the safety attitude questionnaire, which include six dimensions. Higher scores represented more positive attitudes. An analysis of variance was used to compare socio-demographic differences per position, marital status and education; t-tests were used for sex, age and experience. Results A total of 1024 (85.33%) valid questionnaires were returned. The mean score of the six dimensions was 73.74/100; work conditions (80.19) had the highest score of all the dimensions, and safety climate (70.48) had the lowest. Across distinct dimensions, there were significant differences in perceptions of patient safety culture per sex, age, years of experience, position, marital status and education level (P Conclusions The findings can help in assessing perceived patient safety culture among healthcare employees and identifying dimensions that require improvement. Interventions aimed at specific socio-demographic groups are necessary to improve patient safety culture.

Background Traditional “inverted triangle” healthcare resources allocation model in China has wasted a lot of health resources. The Chinese health reform began to strengthens the role of the primary health institutions in delivering primary health care especially in rural areas in the background of large development gap between urban-rural health and rapid growth in the incidence of chronic diseases in rural. We take hypertensive patients as an example, to verify the effect of policy implementation through distribution characteristics of rural primary health institutions preference of hypertensive patients and explore the influencing factor that promoting rationalized use of medical care for patients with chronic disease as well as rational allocation of health resources in rural areas. Methods A cross-sectional survey was conducted in Heilongjiang, a province in northeastern China by using a self-designed questionnaire. Stratified cluster sampling was used to choose 484 hypertensive patients from two villages in Heilongjiang province in 2010. Results About 88.4% of respondents reported preferred primary health institutions (83.5% preferred village clinics and 4.9% preferred township hospitals), 49.4% of respondents knew hypertension management administered by primary health institutions, 53.5% received hypertension education from primary care physicians, more than half of respondents reported that they didn’t receive telephone interviews and family visits from primary care physicians over the past 6 months. Residence closer to the primary health institutions (OR = 10.360), trust in village doctors (OR = 7.323), elders (OR = 3.001), and asked for return visits by primary health physicians (OR = 2.073) promote preferences for primary health institutions. Conclusions: Accessibility to primary healthcare and doctor-patient trust stimulate patients to choose the primary health institutions. Primary health institutions should improve general approach to hypertension management and enhance the ability of providing basic public health services.

Background We examined the physiological, household, and spatial agglomeration characteristics of the health poverty population in China. We identified weak links that affect the implementation of the medical insurance and further improve its effectiveness for health poverty alleviation. Methods A national representative sample from the China Health and Retirement Longitudinal Study (CHARLS) was analyzed. The WHO recommended method was adopted to calculate catastrophic health expenditure (CHE) and impoverishment by medical expenses (IME). We created a binary indicator for IME as the outcome variable and applied the treatment-effect model to analyze the determinants of IME. Results The incidence of IME was 7.2% of the overall population, compared to 20.3% of the sample households trapped in CHE. The incidence of IME enrolled in insurance schemes was 7.4% higher than that of uninsured families (4.8%). Economic level, living area, family size, age of household head, having hospitalized members, and participating in insurance were statistically significant for the occurrence of IME. Conclusions The original poverty-promoting policies has not reached the maximum point of convergence with China’s current demand for health. The overlapped health vulnerabilities exacerbated the risk of poverty among the elderly and households with high health needs and utilization. In addition, the medical insurance schemes have proven to be insufficient for protection against economic burden of poor households. So, special health needs, age, and household capacity to pay should be comprehensively considered while strengthening the connection between the disease insurance scheme with supplementary insurance.

Background: This study aimed to explore the demographic and distributive features of acute hemorrhagic conjunctivitis (AHC). We constructed seasonal autoregressive integrated moving average (SARIMA) and exponential smoothing (ETS) models to predict its trend in incidence in mainland China and provided evidence for the government to formulate policies regarding AHC prevention. Methods: Data regarding the distribution and demographic characteristics of AHC in China from 2011–2016 were retrieved from the Public Health Scientific Data website. Monthly AHC data from January 2011 to June 2019 were used to establish and evaluate the SARIMA and ETS models. Results: During 2011–2016, a total of 213,325 cases were reported; 46.01% were farmers, patients aged ≤9 years had the highest risk, and the male:female ratio was 1.31:1. Guangxi and Guangdong had the highest number of reported AHC cases. The SARIMA (0, 0, 1) (2, 0, 0) 12 model with the minimum root mean squared error and mean absolute percentage error were finally selected for in-sample simulation. Conclusions: AHC remains a serious public health problem in Southern and Eastern China that mainly affects farmers and children younger than 9 years. It is recommended that the health administration strengthen the publicity and education regarding AHC prevention among farmers and accelerate the development of related vaccines and treatment measures. Keywords: Acute hemorrhagic conjunctivitis, Seasonal autoregressive integrated moving average model, Exponential smoothing model, Time series analysis, Forecasting, China

Background Integration of medical insurance schemes has been prioritized as one of the key strategies to address inequity in China’s health system. The first pilot attempt to integrate started in 2003 and later expanded nationwide. This study aims to assess its intended impact on inequity in inpatient service utilization and identify the main determinants contributing to its ineffectiveness. Methods A total of 49,365 respondents in the pilot integrated area and 77,165 respondents in the non-integration area were extracted from the Fifth National Health Services Survey. A comparative analysis was conducted between two types of areas. We calculate a concentration index (CI) and horizontal inequity index (HI) in inpatient service utilization and decompose the two indices. Results Insurance integration played a positive role in reducing inequality in inpatient service utilization to some extent. A 13.23% lower in HI, a decrease in unmet inpatient care and financial barriers to inpatient care in the pilot integrated area compared with the non-integration area; decomposition analysis showed that the Urban-Rural Residents Basic Medical Insurance, a type of integrated insurance, contributed 37.49% to reducing inequality in inpatient service utilization. However, it still could not offset the strong negative effect of income and other insurance schemes that have increased inequality. Conclusions The earlier pilot attempt for integrating medical insurance was not enough to counteract the influence of factors which increased the inequality in inpatient service utilization. Further efforts to address the inequality should focus on widening access to financing, upgrading the risk pool, reducing gaps within and between insurance schemes, and providing broader chronic disease benefit packages. Social policies that target the needs of the poor with coordinated efforts from various levels and agencies of the government are urgently needed.

ObjectivesThis study aims to investigate patient safety culture in secondary hospitals of Heilongjiang, Northeast China, and explore the implications of patient safety culture and practices through the perspectives of various healthcare workers.MethodsA cross-sectional survey using the Safety Attitude Questionnaire (SAQ) was conducted to ascertain the status of patient safety culture in nine secondary hospitals across the six dimensions of the SAQ. Among the 900 staff members who were invited to participate, 665 completed the questionnaire. Descriptive statistics were used to calculate the general means and standard deviations of the patient safety culture dimensions and other numerical variables, and F-test and a multivariate regression analysis were used to statistically analyze the differences in perceptions of safety culture considering the differences in demographic characteristics. All statistical analyses were performed using SPSS v. 22.0.ResultsThe respondents rated job satisfaction as the highest among all six dimensions of the SAQ, followed in order by teamwork climate, working conditions, and stress recognition (the lowest). There were significant differences among the dimensions of patient safety culture and other factors, such as gender, age, job position, and education. Compared with previous studies, teamwork climate and working conditions scores were quite high, while stress recognition score was very low. We also found differences in patient safety culture by demographic characteristics.ConclusionsThe findings revealed the patient safety culture attitudes of healthcare workers in secondary hospitals of Heilongjiang, and provided baseline data for related future research. This evidence may also help government health policymakers and hospital administrators understand related challenges and develop strategies to improve patient safety culture in secondary hospitals of China and perhaps also in other developing countries.

ObjectivesIn light of government investment over the past decade, we explored the capacity for disaster response in Heilongjiang Province, identifying the factors that affect response capacity.MethodsWe surveyed 1257 medical staff in 65 secondary and tertiary hospitals in Heilongjiang province to explore their perceptions of disaster management capacity using a cross-sectional multistage, stratified cluster sampling method.ResultsAll tertiary hospitals (100%) and most secondary hospitals (93%) have documented disaster management plans that are regularly reviewed. In secondary hospitals, drills were less prevalent (76.7%) but the occurrence of simulated training exercises was closer to tertiary hospitals (86.0%). We noted that 95.4% of all hospitals have leadership groups responsible for disaster preparedness capacity building, but only 10.8% have a stockpiled network of reserve supplies.ConclusionsAlthough response capacity has improved in Heilongjiang Province, vulnerabilities remain. We recommend that priorities should be targeted at preparedness capacity building, in terms of reliable and relevant operational response plans, the expansion of existing response mechanisms to oversee local education and scenario training, and to ensure there is sufficient access to protective equipment and materials, either held in reserve, or alternatively by activating resilient supply chain mechanisms. (Disaster Med Public Health Preparedness. 2018;12:176–183)

Using a cross-sectional survey design from 11 public tertiary hospitals (a specialist hospital, four Chinese medicine hospitals, and six general hospitals) in the urban areas of Heilongjiang, we determined the nature of workplace violence that medical staff have encountered in Chinese hospitals and identified factors associated with those experiences of violence. A total of 1129 health workers participated. The specialist hospital had the highest prevalence of physical violence (35.4%), while the general hospitals had the highest prevalence of non-physical violence (76%). Inexperienced medical staff (p &lt, 0.001) were more likely to suffer non-physical violence than physical violence in Chinese medicine hospitals compared to experienced staff. Medical units (p = 0.001) had a high risk of non-physical violence, while surgical units (p = 0.005) had a high risk of physical violence. In general hospitals, staff with higher levels of anxiety about workplace violence were more vulnerable to both physical violence (1.67, 95% CI 1.36–2.10) and non-physical violence (1.309, 95% CI 1.136–1.508) compared to those with lower levels of anxiety, while rotating shift workers had a higher odds of physical violence (2.2, 95% CI 1.21–4.17) and non-physical violence (1.65, 95% CI 1.13–2.41) compared to fixed day shift workers. Thus, prevention should focus not only on high-risk sections of hospitals, but also on the nature of the hospital itself.

Background International reports indicating that around 10–50% of health care staff are exposed to violence every year; in certain settings, this rate might reach over 85%. Evidence has shown that people who experience psychological violence are seven times as likely to be victims of physical violence. Although there have been numerous studies on WPV in general hospitals, there is no consensus regarding the current status of psychological violence directed at health care workers in township hospitals in China. The purpose of this study was to estimate the prevalence and the risk factors of psychological violence in Chinese township hospitals. Methods A retrospective cross-sectional survey of township hospitals general practitioners and general nurses was conducted in Heilongjiang Province, China.Descriptive analyses and binary logistic regression analysis were used to estimated the prevalence and the risk factors of psychological violence. Results Regardless of whether the assessment period was the past 12 months, past 36 months, or during their entire career,GPs and nurses reported that verbal abuse was the most common type of psychological violence (28.05, 30.28, 38.69 and 40.45%, 43.86, 54.02%).The main perpetrator was patients’ relatives. Most participants responded to violence with “pretend nothing happened”, 55.63% of GPs and 62.64% of nurses reported that the perpetrator received no punishment. Around 47.62% of respondents reported that their workplace had no procedures for reporting violence. When workplaces did have a reporting system, 57.73% knew how to use them. Only 36.98% had training in managing aggression and violence. General nurses, individuals 35 years or younger, those with higher professional titles and who work in shifts are at greater risk of psychological violence. Conclusions Our results indicate a high prevalence of psychological violence in Chinese township hospitals, which can no longer be ignored. Effective measures should be taken to prevent and respond to workplace violence(WPV), especially psychological violence. Trial registration (Project Identification Code: HMUIRB20160014), Registered May 10, 2016.

ObjectivesSleep problems are common among healthcare workers, especially among those who work in tertiary hospitals; however, studies focusing on healthcare workers in tertiary hospitals in China are limited. Therefore, we aimed to examine the prevalence of sleep problems among tertiary hospital employees in China and identify associated factors.DesignCross-sectional questionnaire survey study.SettingThe study was conducted in 317 departments at 33 tertiary hospitals in the Heilongjiang Province, China.ParticipantsThe study included a representative sample of 4007 healthcare workers, including clinicians, medical technicians and office workers, who were selected using a multistage cluster sampling method. Ultimately, 3810 participants completed valid questionnaires, yielding a response rate of 95%.Primary and secondary outcome measuresParticipants completed a structured questionnaire which collected data regarding demographics, sleep problems, employment, chronic pain and health-related behaviours. A two-level logistic regression model was constructed to examine determinants of sleep problems.ResultsWe found that nearly half of the respondents reported experiencing sleep problems. The two-level logistic model suggested a positive association of sleep problems with headache (OR=2.64, 95% CI=2.27 to 3.07), working hours (OR=1.41, 95% CI=1.20 to 1.66) and night shifts (OR=1.43, 95% CI=1.21 to 1.69). In contrast, regular diet (OR=0.44, 95% CI=0.36 to 0.53) and exercise (OR=0.65, 95% CI=0.53 to 0.80) protected the study population against sleep problems.ConclusionsWe found that sleep problems are prominent among tertiary hospital employees in China. The risk factor most strongly associated with sleep problems was headaches. To alleviate sleep problems in this population, medical institutions and health policy makers should establish reasonable working schedules and night-shift work systems, while the healthcare workers themselves should pay attention to their chronic pain problems and engage in regular diet and exercise.

The study's objectives were to: 1) use social support theory to examine factors influencing healthcare workers' opinions about workplace violence (WPV) prevention strategies, and 2) to determine the types of support that general practitioners (GPs) and general nurses sought and expected to use after WPV exposure. A cross-sectional survey was used to assess a sample of 448 GPs and 412 general nurses from 90 township hospitals located in Heilongjiang province, China. Results revealed that workers exposed to physical, psychological or both WPV types had a strong opinion about the necessity of improving diagnosis/treatment competence, developing violence prevention guidelines and plans, using protective equipment, and reinforcing staff by providing back-up support. The last two strategies were also selected by tertiary hospital workers in our previous study. In addition, workers with high anxiety selected the following prevention strategies as most effective: improving doctor-patient communication skills; installing cameras on wards; keeping work areas bright; improvements in violence reporting, statistics, and interventions; security patrols in the key departments; reinforcing staff; and correcting inaccurate media perspectives and reports. The last four strategies were also selected by tertiary hospital workers. All respondents expected to receive organisational and social support. In conclusion, these prevention strategies should be tailored to the different requirements of specific populations. Furthermore, it is necessary for organisations, the public, and policymakers to provide powerful support in WPV prevention.

Objective Deteriorations in the patient-provider relationship in China have attracted increasing attention in the international community. This study aims to explore the role of trust in patient satisfaction with hospital inpatient care, and how patient-provider trust is shaped from the perspectives of both patients and providers. Methods We adopted a mixed methods approach comprising a multivariate logistic regression model using secondary data (1200 people with inpatient experiences over the past year) from the fifth National Health Service Survey (NHSS, 2013) in Heilongjiang Province to determine the associations between patient satisfaction and trust, financial burden and perceived quality of care, followed by in-depth interviews with 62 conveniently selected key informants (27 from health and 35 from non-health sectors). A thematic analysis established a conceptual framework to explain deteriorating patient-provider relationships. Findings About 24% of respondents reported being dissatisfied with hospital inpatient care. The logistic regression model indicated that patient satisfaction was positively associated with higher level of trust (OR = 14.995), lower levels of hospital medical expenditure (OR = 5.736-1.829 as compared with the highest quintile of hospital expenditure), good staff attitude (OR = 3.155) as well as good ward environment (OR = 2.361). But patient satisfaction was negatively associated with medical insurance for urban residents and other insurance status (OR = 0.215-0.357 as compared with medical insurance for urban employees). The qualitative analysis showed that patient trust-the most significant predictor of patient satisfaction-is shaped by perceived high quality of service delivery, empathic and caring interpersonal interactions, and a better designed medical insurance that provides stronger financial protection and enables more equitable access to health care. Conclusion At the core of high levels of patient dissatisfaction with hospital care is the lack of trust. The current health care system reform in China has yet to address the fundamental problems embedded in the system that caused distrust. A singular focus on doctor-patient inter-personal interactions will not offer a successful solution to the deteriorated patient-provider relationships unless a systems approach to accountability is put into place involving all stakeholders.

ObjectivesThis study aimed to identify factors that influence people’s willingness to volunteer and participation in emergency volunteering in northern China.Design/SettingThis study was conducted in Heilongjiang province in September and October 2014 using a mixed methods approach, which included a cross-sectional questionnaire survey on community residents and in–depth interviews with community residents and relevant organisational managers and officials in relation to emergency responses. A stratified cluster sampling strategy was employed to select questionnaire respondents.Participants2686 respondents completed the questionnaire survey; 19 key informants were interviewed.Primary and secondary outcome measuresWillingness to volunteer was the major concern of this study. Self-reported past experience of the participants in emergency volunteering served as a secondary outcome.Results65.7% of respondents were willing to volunteer in emergencies. 24.3% of respondents had participated in emergency actions. Higher levels of willingness to volunteer and participation in volunteering were found in those who resided in rural areas (OR=1.308 (1.064 to 1.608) for willingness; OR=1.518 (1.208 to 1.908) for participation), had stronger community attachment (OR=1.720 (1.429 to 2.069) for willingness; OR=1.547 (1.266 to 1.890) for participation), had higher recognition of responsibility (OR=1.981 (1.498 to 2.619) for willingness; OR=1.517 (1.177 to 1.955) for participation), demonstrated preparedness behaviour (OR=1.714 (1.424 to 2.064) for willingness; OR=1.391 (1.151 to 1.681) for participation) and were covered by injury insurance (OR=1.335 (1.102 to 1.619) for willingness; OR=1.822 (1.500 to 2.214) for participation). The in-depth interviews revealed that an inappropriate policy environment and poor volunteer organisational management were major barriers for converting willingness into actions.ConclusionA relatively high level of willingness to volunteer in emergencies in northern China is associated with a range of individual, community and institutional factors. Efforts should be made to translate willingness into effective contributions to the emergency response system. This can be done through improving policies, regulations, coordination mechanisms and volunteer training and support.

ObjectivesWorkplace violence is relatively frequent among medical professionals who work in otorhinolaryngology units. This phenomenon reduces the quality of provided medical care and increases the incidence of depressive symptoms among physicians and nurses, seriously affecting their job satisfaction and work efficiency with a negative attitude towards providing treatment. Few existing studies have assessed workplace-violence-related factors associated with depressive symptoms among otorhinolaryngology physicians and nurses.MethodsWe conducted a cross-sectional study in grade A tertiary hospitals of Heilongjiang province in Northern China, to evaluate the occurrence and level of depressive symptoms among otorhinolaryngology physicians and nurses and to analyse the relationship between them and workplace-violence-related risk factors and demographic variables.ResultsOf all our participating professionals, (379 otorhinolaryngologists and 273 nurses), 57.2% were found to have depressive symptoms, whereas, of the respondents who had suffered from physical violence, 71.25% had depressive symptoms. Professionals with less than 1 year of experience, as well as professionals who more frequently worked alone, were more likely to suffer from depressive symptoms than their colleagues.ConclusionsThis research addresses an emerging issue of clinical practice, and its results differ from those of previous studies; specifically, it indicates that the frequency of depressive symptoms among otorhinolaryngology physicians and nurses may be influenced by physical violence, the number of coworkers they have for more than half of their working hours and other workplace-violence-related factors. To reduce the depressive symptoms caused by workplace violence and improve the quality of medical services, medical institutions should implement effective measures to prevent the occurrence of physical violence, strengthen team cooperation ability and increase peer support.

A cross-sectional survey of healthcare professionals from 19 hospitals in six cities of Heilongjiang Province, China was conducted. This study had two objectives: (1) to examine the factors influencing healthcare workers’ opinions of strategies to prevent workplace violence, using social support theory, and (2) to encourage healthcare organisations and the larger society to offer greater support to healthcare workers. The respondents exposed to workplace violence expected to receive organisational and social support. Those exposed to psychological violence had a strong opinion of the need for target training to strengthen their competence in responding to violence (OR = 1.319, 95% CI: 1.034–1.658) and enacting workplace violence legislation (OR = 1.968, 95% CI: 1.523–2.543).Those exposed to physical violence thought it might be useful to reinforce staff with back-up support (OR = 3.101, 95% CI: 1.085–8.860). Those exposed to both types of violence and those with high anxiety levels need greater support at both the organisational and societal levels.

Objectives To determine the prevalence of workplace violence that Chinese nurses have encountered, identify risk factors and provide a basis for future targeted interventions. Setting Heilongjiang, a province in northeast China. Methods A cross-sectional survey. Participants A total of 588 nurses provided data. There were also in-depth interviews with 12 nurses, 7 hospital administrators and 6 health officials. Results A total of 7.8% of the nurses reported physically violent experiences and 71.9% reported non-physically violent experiences in the preceding year. Perpetrators were patients or their relatives (93.5% and 82%, respectively), and 24% of nurses experienced non-physical violence that involved Yi Nao (gangs specifically targeting hospitals). Inexperienced nurses were more likely to report physical (13.2%) or non-physical (89.5%) violence compared with experienced nurses. Graduate-level nurses were more likely to perceive and report non-physical violence (84.6%). Nurses who worked rotating shifts were 3.668 times (95% CI 1.275 to 10.554) more likely to experience physical violence, and 1.771 times (95% CI 1.123 to 2.792) more likely to experience non-physical violence compared with nurses who worked fixed day shifts. Higher anxiety levels about workplace violence and work types were associated with violence. Interviewees perceived financial burdens, unsatisfactory treatment outcomes and miscommunications as influencing factors for workplace violence. Conclusions Preplacement education should focus on high-risk groups to reduce workplace violence. Increased awareness from the public and policymakers is necessary to develop effective control strategies at individual, hospital and national levels.

This research aimed to determine the prevalence of workplace violence (WPV) against healthcare workers, explore the frequency distribution of violence in different occupational groups, and determine which healthcare occupation suffers from WPV most frequently. Furthermore, the current study aimed to compare risk factors affecting different types of WPV in Chinese hospitals. A cross-sectional design was utilized. A total of 1899 healthcare workers from Heilongjiang, a province in Northeastern China, completed the questionnaire. Of the respondents, 83.3% reported exposure to workplace violence, and 68.9% reported non-physical violence. Gender, education, shift work, anxiety level, and occupation were significantly correlated with physical violence (p < 0.05 for all correlations). Additionally, age, professional title, and occupation were correlated with non-physical violence, which critically affected doctors. Thus, gender, age, profession, anxiety, and shift work were predictive of workplace violence toward healthcare workers. Doctors appeared to experience non-physical workplace violence with particularly higher frequency when compared to nurses and other workers in hospitals. For healthcare workers, interventions aimed at WPV reduction should be enacted according to the types of violence, profession, and other factors underlying the various types of WPV in hospitals.

We conducted this study to determine levels and correlates of hypertension knowledge among rural Chinese adults, and to assess the association between knowledge levels and salty food consumption among hypertensive and non-hypertensive populations. This face-to-face cross sectional survey included 665 hypertensive and 854 non-hypertensive respondents in the rural areas of Heilongjiang province, China. Hypertension knowledge was assessed through a 10-item test; respondents received 10 points for each correct answer. Among respondents, the average hypertension knowledge score was 26 out of a maximum of 100 points for hypertensive and 20 for non-hypertensive respondents. Hypertension knowledge was associated with marital status, education, health status, periodically reading books, newspapers or other materials, history of blood pressure measurement, and attending hypertension educational sessions. Hypertension knowledge is extremely low in rural areas of China. Hypertension education programs should focus on marginal populations, such as individuals who are not married or illiterate to enhance their knowledge levels. Focusing on educational and literacy levels in conjunction with health education is important given illiteracy is still a prominent issue for the Chinese rural population.

Workplace violence in Chinese township hospitals is a major public health problem. We identified the risk factors of healthcare workers' worry about experiencing workplace violence in 90 Chinese township hospitals and determined specific measures for differing stages of violence (based on crisis management theory). Participants were 440 general practitioners and 398 general nurses from Heilongjiang Province, China (response rate 84.6%). One hundred and six (12.6%) respondents reported being physically attacked in their workplace in the previous 12 months. Regarding psychological violence, the most common type reported was verbal abuse (46.0%). While most (85.2%) respondents had some degree of worry about suffering violence, 22.1% were worried or very worried. Ordinal regression analysis revealed that being ≤35 years of age, having a lower educational level, having less work experience, and working night shifts were all associated with worry about workplace violence. Furthermore, those without experience of such violence were more likely to worry about it. Respondents' suggested measures for controlling violence included "widening channels on medical dispute solutions," "improving doctor-patient communication," and "advocating for respect for medical workers via the media." Results suggest the target factors for reducing healthcare workers' worry by according to the type of education and training and possible measures for limiting workplace violence in township hospitals.

The infiltrative duct carcinoma (IDC) is the most common malignant breast cancer in females and genetic factors appear to play a significant role in the susceptibility of IDC. The LFA-1 is a crucial co-stimulatory molecule in immune system and may affect the development of breast IDC. In order to clarify the association of LFA-1 polymorphisms with IDC, a case-control study was conducted in women from Heilongjiang Province, Northeast of China. We scrutinized four genetic polymorphisms in LFA-1 gene, which may influence the activity and function of LFA-1. Our research subjects consist of 537 cases with IDC and 577 age-matched healthy controls. Genotypes were determined by PCR-RFLP. Data were analyzed using the χ(2) test by SPSS 13.0 and Haploview 4.1 softwares. The association between LFA-1 polymorphisms and the clinical features of IDC was analyzed. In rs2230433, the frequency of GG genotype and G allele was lower in cases than in controls (P = 0.0316 and 0.0480). And rs2230433, CG genotype was higher in cases (P = 0.0397). In rs8058823, the frequency of AA genotype and A allele was lower in cases than in controls (P = 0.00000418 and 0.00000267). And rs8058823, AG genotype was higher in cases (P = 0.00000747). The frequency of haplotype CCGA was lower in patients. Significant association was shown between the four SNPs of LFA-1 gene and estrogen receptor (ER), progesterone receptor (PR), C-erbB-2, and P53 statuses. In addition, no association was found between LFA-1 gene polymorphisms and tumor size, and neither was it between LFA-1 gene polymorphisms and lymph node metastasis. Our results primarily suggested that LFA-1 gene polymorphisms may predict the sporadic breast IDC risk and prognosis factors in Chinese Han women in Heilongjiang Province.

PURPOSE: The purpose of this study is to identify risk factors of physical violence in Chinese township hospitals. METHODS: A cross-sectional survey was used in a sample of 442 general practitioners and 398 general nurses from 90 township hospitals located in Heilongjiang province, China (response rate = 84.8%). RESULTS: A total of 106 of the 840 (12.6%) respondents reported being physically attacked in their workplace in the previous 12 months. Most perpetrators were the patients' relatives (62.3%), followed by the patient (22.6%); 73.6% of perpetrators were aged between 20 and 40 years. Of the physical violence incidents, about 56.6% (n = 60) resulted in a physical injury, and 45.4% of respondents took two or three days of sick leave. Reporting workplace violence in hospitals to superiors or authorities was low (9.4%). Most respondents (62.8%) did not receive training on how to avoid workplace violence. Logistic regression analyses indicated that general nurses, aged 35 years or younger, and with a higher-level professional title were more likely to experience physical violence. Healthcare workers with direct physical contact (washing, turning, lifting) with patients had a higher risk of physical violence compared to other health care workers. Procedures for reporting workplace violence were a protective factor for physical violence; when in place, reporting after psychological violence (verbal abuse, bullying/mobbing, harassment, and threats) was more protective than waiting until an instance of physical violence (beating, kicking, slapping, stabbing, etc.). CONCLUSIONS: Physical violence in Chinese township hospitals is an occupational hazard of rural public health concern. Policies, procedures, and intervention strategies should be undertaken to manage this issue. Language: en

Objective This article aims to identify factors that shape the knowledge, attitudes and behaviours of community residents in China9s Heilongjiang province towards emergency preparedness. Findings of such a study may provide evidence to support the development of effective public risk communication strategies and education campaigns. Design A cross-sectional household questionnaire survey was conducted in Heilongjiang province in 2014. A stratified cluster sampling strategy was employed to select study participants. The questionnaires were administered using face-to-face interviews. 2800 questionnaires were completed, among which 2686 (95.9%) were considered valid for data analyses. A multivariate logistic regression model was adopted to identify the extent to which the independent variables were associated with emergency preparedness. Results Fewer than 5% respondents were well prepared for emergency. Over half (52%) of poorly prepared respondents did not know what to do in emergency; women (OR=1.691), higher household income (OR ranging from 1.666 to 2.117), previous experience with emergency (OR=1.552), higher levels of knowledge about emergency (OR=2.192), risk awareness (OR=1.531), self-efficacy (OR=1.796), as well as positive attitudes towards emergency preparedness (OR=2.265) were significant predictors for emergency preparedness. Neither educational attainment nor exposure to awareness-raising entered into the logic regression model as a significant predictor for emergency preparedness. Conclusions The level of emergency preparedness in Heilongjiang residents is very low, which is linked with poor knowledge and attitudes of the residents towards emergency preparedness. Future emergency awareness campaigns should be more focused and tailored to the needs of intended audience, taking into consideration of their usual source of information and knowledge in relation to emergency.

Objectives To determine the emergency preparedness competency specific to public health inspectors (PHIs), preparedness limitations and needs of the workforce, as well as to identify important factors that affect the preparedness competency of PHIs. Setting Cross-sectional survey was conducted in Heilongjiang, a province in northeastern China. Participants A questionnaire was administered to a sample of 368 PHIs from 17 public health inspection agencies, chosen by stratified cluster sampling strategy. 9 PHIs and 6 agency9s leaders were invited to participate in an in-depth interview. Outcome measures Self-rated preparedness competency in quantitative study was measured. Multivariate logistic regression model was used to test the associations between individual determinants and self-rated preparedness competency. Key themes relating to preparedness competency of PHIs in qualitative study were analysed. Results Although 82% of PHIs highly rated their general preparedness competency, there were significant differences among the assessment on specific domains of their competency. Comparing with attitude, the domains of skills and knowledge tend to be lower (p=0.000). Awareness on one9s own responsibilities regarding emergency response work was identified as the most important factor associated with preparedness competency (adjusted OR=6.33, 95% CI 3.30 to 12.16). Lack of explicit national job requirements, overlapping responsibilities and poor collaboration among agencies, together with poor knowledge and skills level of personnel, led to an ambiguity of responsibility, and hindered the preparedness competency enhancement of PHIs furthermore. Conclusions Ambiguity responsibility in emergency response is still a prominent issue that hinders the further improvement on the preparedness competency for PHIs’ in China. Intensified capacity-building activities targeting at individuals’ weakness in specific knowledge and skills are urgently needed; in addition, capacity building at policy and system level as well as agency levels is of equal importance.

Background Since 2003 and 2005, National Pilot Medical Financial Assistance Scheme (MFA) has been implemented in rural and urban areas of China to improve the poorest families' accessibility to health services. Local governments of the pilot areas formulated various benefit packages. Comparative evaluation research on the effect of different benefit packages is urgently needed to provide evidence for improving policy-making of MFA. This study was based on a MFA pilot project, which was one component of Health VIII Project conducted in rural China. This article aimed to compare difference in health services utilization of poor families between two benefit package project areas: H8 towns (package covering inpatient service, some designated preventive and curative health services but without out-patient service reimbursement in Health VIII Project,) and H8SP towns (package extending coverage of target population, covering out- patient services and reducing co-payment rate in Health VIII Supportive Project), and to find out major influencing factors on their services utilization. Methods A cross-sectional survey was conducted in 2004, which used stratified cluster sampling method to select poor families who have been enrolled in MFA scheme in rural areas of ChongQing. All family members of the enrolled households were interviewed. 748 and 1129 respondents from two kinds of project towns participated in the survey. Among them, 625 and 869 respondents were included (age≥15) in the analysis of this study. Two-level linear multilevel model and binomial regressions with a log link were used to assess influencing factors on different response variables measuring service utilization. Results In general, there was no statistical significance in physician visits and hospitalizations among all the respondents between the two kinds of benefit package towns. After adjusting for major confounding factors, poor families in H8SP towns had much higher frequency of MFA use (β = 1.17) and less use of hospitalization service (OR = 0.7 (H8SP/H8), 95%CI (0.5, 1.0)) among all the respondents. While calculating use of hospital services among those who needed, there was significant difference (p = 0.032) in percentage of hospitalization use between H8SP towns (46%) and H8 towns (33%). Meanwhile, the non-use but ought-to-use hospitalization ratio of H8SP (54%) was lower than that of H8 (67 %) towns. This indicated that hospitalization utilizations had improved in H8SP towns among those who needed. Awareness of MFA detailed benefit package and presence of physician diagnosed chronic disease had significant association with frequency of MFA use and hospitalizations. There was no significant difference in rate of borrowing money for illness treatment between the two project areas. Large amount of medical debt had strong association with hospitalization utilization. Conclusions The new extended benefit package implemented in pilot towns significantly increased the poor families' accessibility to MFA package in H8SP than that of H8 towns, which reduced poor families' demand of hospitalization services for their chronic diseases, and improved the poor population's utilization of out-patient services to some degree. It can encourage poor people to use more outpatient services thus reduce their hospitalization need. Presence of chronic disease and hospitalization had strong association with the presence of large amount of medical debt, which indicated that: although establishment of MFA had facilitated accessibility of poor families to this new system, and improved service utilization of poor families to some degree, but its role in reducing poor families' medical debt resulted from chronic disease and hospitalization was still very limited. Besides, the following requirements of MFA: co-payment for in-patient services, ceiling and deductibles for reimbursement, limitations on eligibility for diseases reimbursement, also served as most important obstacles for poor families' access to health care. Therefore, there is great need to improve MFA benefit package design in the future, including extending to cover out-patient services, raising ceiling for reimbursement, removing deductibles of MFA, reducing co-payment rate, and integrating MFA with New Rural Cooperative Medical Scheme more closely so as to provide more protection to the poor families.

Background Local health departments are the backbone of public health emergency (PHE) response plans. The front line of emergency response preparedness is people. Role perceptions of individual staff members of a given organization strongly affect response probability and performance. Therefore, the aim of this study was to determine local public health employees’ perceptions of emergency response responsibilities, identify factors that influence their perception, and indicate the challenges and bottlenecks of PHE response in the Health Inspection Institution (HII) after its separation from China’s multiple Centers for Disease Control and Prevention (CDC). Methods We used a stratified randomized sample survey to examine HII workers’ knowledge of their own duties concerning PHE response in 17 facilities in Heilongjiang, a province in northeastern China. Data were collected from May to July 2010 using a 9-item combined question inquiring about the workers’ statutory duties. Results Of 348 administered surveys, 309 were returned for an overall response rate of 88.8 %. Overall, the correct recognition rate of PHE responsibilities was low. Some HII workers were confused about their responsibilities required by law, regulations, and emergency response plans. A quarter of all the respondents had the lowest knowledge for PHE responsibilities. Factors influencing their perceptions of responsibilities were department, work experience in a CDC, and PHE response experience. Conclusions To improve preparedness for a PHE, efforts are needed to train, support, and monitor the workers’ knowledge and competencies in PHEs as part of an organizational change; the worker’s knowledge of their responsibilities should be measured and used as an indicator of preparedness for a PHE, and training should be undertaken where there are deficiencies. Management should also encourage workers in the departments of food hygiene/school health surveillance to be more involved in PHE preparedness and response issues.